PART III. REFORM. FOCUS ON HUMAN BIOLOGY

We welcome your use of this resource but please cite:

PSGRNZ (2026) Reclaiming Health: Reversal, Remission & Rewiring. Understanding & Addressing the Primary Drivers of New Zealand’s Metabolic & Mental Health Crisis. Bruning, J.R., Physicians & Scientists for Global Responsibility New Zealand. ISBN 978-1-0670678-2-3

Chapter 9. Type 2 Diabetes: Remission is Real.

Type two diabetes mellitus (T2DM) has traditionally been characterised as a chronic, progressive condition not amenable to reversal. It was believed that pancreatic beta cell function was permanently lost by all people who were diagnosed with T2DM. However, clinicians working with patients now understand that the permanent loss of beta cell function is rare. Clinicians report that the sooner the patient adopts a low-carbohydrate diet, after a diagnosis of prediabetes or T2DM, the more likely natural insulin metabolism can resume. [1] Reversal and/or remission of T2DM is well documented in 2025.

T2DM remission, defined as normal blood glucose levels for 3 months or more in the absence of pharmacological therapy is dependent on factors including the length of time with T2DM, personal capacity and support networks.[2]

Physicians adopting a low-carbohydrate approach with patients have demonstrated that long-term improvements in blood glucose control (lower HbA1c levels),[3] can lead to remission of prediabetes and T2DM[4] [5] and reduce or eliminate dependence on diabetes medication use. [6] [7] [8] [9]

A battery of papers has been published in recent years which demonstrate broad improvement across metabolic disease parameters beyond T2DM. Trials consistently demonstrate that ketogenic diets reduce seizure risk and improve neurologic and cardiometabolic outcomes.[10] [11] [12] [13] Studies report:

Improvements in kidney function, [14]
Improvements in neurodegenerative conditions. E.g. Parkinson’s and Alzheimer’s disease.[15] [16] [17]
Reduced risk for cancer.[18] [19] [20]
Lower blood pressure.[21]
Improved mitochondrial function.[22]
Improvements in biomarkers for cardiovascular disease.[23] [24] [25] [26]

Type 1 diabetes mellitus: Carb Control Sees Improvements in Health Biomarkers & Quality of Life.

Type 1 diabetics (T1DM) who adopt a long-term low carb or ketogenic diet can experience improvements in quality of life and reduce risk for chronic conditions that are commonly associated with T1DM.[27] People with T1DM have a ten-fold higher risk for cardiovascular disease risk compared to the general population. Case studies assessing the metabolic parameters of T1DM individuals on ketogenic diets to manage glycemia and lower insulin requirements, have demonstrated improvements in biomarkers which suggest that such individuals, if this diet is maintained over time, can reduce risk for cardiovascular disease and other complications, compared to individuals that follow a conventional T1DM approach.[28] [29] [30] [31]

A protocol was developed in 2021 to support parents to adopt and monitor a low-carbohydrate/ketogenic approach in children and adolescents.[32] Diabetic ketoacidosis (where the body lacks sufficient insulin) may not be a major risk for T1DM individuals who pursue ketogenic diet.[33] Research is still in its infancy and this approach ‘may be cautiously considered in highly motivated, well-supported adult patients with structured education and access to continuous glucose and ketone monitoring’.[34]

Chapter 10. Whole of System Reform: Health Coaching Central to Reversal & Remission of Metabolic & Mental Illness.

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REFERENCES

NB: Number order differs from the original Reclaiming Health publication (PDF).

[1] Taylor R, Al-Mrabeh A, Zhyzhneuskaya S, et al. (2018). Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery. Cell Metabolism, 28(4), 547–556.e3. DOI: 10.1016/j.cmet.2018.07.003.

[2] Hallberg SJ, McKenzie AL, Williams PT, et al. (2018). Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther. 9(2):583-612. doi: 10.1007/s13300-018-0373-9. Epub 2018 Feb 7. Erratum in: Diabetes Ther. 2018 Apr;9(2):613-621. doi: 10.1007/s13300-018-0386-4.

[3] Yuan, X., Wang, J., Yang, S. et al. (2020). Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis. Nutr. Diabetes 10, 38 (2020). DOI: 10.1038/s41387-020-00142-z

[4] Unwin D, Delon C, Unwin J, et al. (2023) What predicts drug-free type 2 diabetes remission? Insights from an 8- year general practice service evaluation of a lower carbohydrate diet with weight loss. BMJ Nutrition, Prevention & Health.

[5] Brown A, McArdle P, Taplin J, Unwin D, Unwin, J, et al. (2022). Dietary strategies for remission of type 2 diabetes: A narrative review. J Hum Nutr Diet. 35:165–178. DOI: 10.1111/jhn.12938.

[6] Unwin D, Khalid AA, Unwin J, et al. (2020). Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years. BMJ Nutr Prev Health.2020;3:285–94 bmjnph‐2020-000072.

[7] MacKay D, Chan C, Dasgupta K et al. (2022). Remission of Type 2 Diabetes. Diabetes Canada Clinical Practice Guidelines Expert Working Group. Can J Diabetes, 46:753-761. DOI: DOI: 10.1016/j.jcjd.2022.10.004.

[8] Lingvay I, Sumithran P, Cohen RV, le Roux CW. (2022) Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. Lancet;399:394–405

[9] Xin Y, Davies A, Briggs A, McCombie L, Messow CM, Grieve E, et al. (2020). Type 2 diabetes remission: 2 year within‐trial and lifetime‐horizon cost‐effectiveness of the Diabetes Remission Clinical Trial (DiRECT)/counterweight‐plus weight management programme. Diabetologia.63(10):2112–22. DOI: 10.1007/s00125-020-05224-2.

[10] Dyńka D, Kowalcze K, Paziewska A. (2022). The Role of Ketogenic Diet in the Treatment of Neurological Diseases. Nutrients. 14(23):5003. DOI: 10.3390/nu14235003.

[11] Patikorn C, Saidoung P, Pham T. et al. (2023). Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials. BMC Med 21:196. DOI:10.1186/s12916-023-02874-y

[12] Nojek P, Zawół M, Zimonczyk M, et al. (2024) Ketogenic diet and metabolic health.

[13] Baylie T, Ayelgn T, Tiruneh M, Tefsa KH (2024). Effect of Ketogenic Diet on Obesity and Other Metabolic Disorders.

[14] Athinarayanan SJ, Roberts CGP, Phinney SD, et al. (2025). Effects of a continuous remote care intervention including nutritional ketosis on kidney function and inflammation in adults with type 2 diabetes: a post-hoc latent class trajectory analysis. Front Nutr. Jun 6(12):1609737. doi: 10.3389/fnut.2025.1609737. PMID: 40547366

[15] Phillips, M.C.L., Deprez, L.M., Mortimer, G.M.N. et al. Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease. Alz Res Therapy 13, 51 (2021). https://doi.org/10.1186/s13195-021-00783-x

[16] Phillips, M.C.L., Picard, M. Neurodegenerative disorders, metabolic icebergs, and mitohormesis. Transl Neurodegener 13, 46 (2024). https://doi.org/10.1186/s40035-024-00435-8

[17] Rong L, Peng Y, Shen Q. et al. (2024). Effects of ketogenic diet on cognitive function of patients with Alzheimer's disease: a systematic review and meta-analysis. J nutrition, health and aging. 28(8):100306. DOI: 10.1016/j.jnha.2024.100306

[18] Duraj, T., Kalamian, M., Zuccoli, G. et al. Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma. BMC Med 22, 578 (2024). https://doi.org/10.1186/s12916-024-03775-4

[19] Phillips MC, Thotathil Z, Hari Dass P, Ziad F and Moon BG: Ketogenic metabolic therapy in conjunction with standard treatment for glioblastoma: A case report. Oncol Lett 27: 230, 2024.

[20] Klement, R. J. (2025). Is the ketogenic diet still controversial in cancer treatment? Expert Review of Anticancer Therapy, 1–5. DOI:10.1080/14737140.2025.2522936

[21] Unwin DJ, Tobin SD, Murray SW, et al. (2019) Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care. Int J Environ Res Public Health, 16(15):2680. doi: 10.3390/ijerph16152680.

[22] Miller VJ, LaFountain RA, Barnhart E. et al. (2020) A ketogenic diet combined with exercise alters mitochondrial function in human skeletal muscle while improving metabolic health. Am J Physiol Endocrinol Metab. 1;319(6):E995-E1007. DOI: 10.1152/ajpendo.00305.2020.

[23] Bhanpuri NH, Hallberg SJ, Williams PT, et al. (2018). Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovasc Diabetol.;17:56. DOI: 10.1186/s12933-018-0698-8

[24] Hu T, Mills KT, YaoL ,et al (2012) Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials, American Journal of Epidemiology, 176(7): S44–S54, DOI:10.1093/aje/kws264

[25] Unwin DJ, Tobin SD, Murray SW, Delon C, Brady AJ.(2019) Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care. Int J Environ Res Public Health. 16(15):2680. DOI: 10.3390/ijerph16152680

[26] Saslow, L.R., Daubenmier, J.J., Moskowitz, J.T. et al. (2017) Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr & Diabetes 7, 304 (2017). DOI:10.1038/s41387-017-0006-9

[27] Turton JL, Brinkworth GD, Parker HM, et al. (2023) Effects of a low-carbohydrate diet in adults with type 1 diabetes: A single arm non-randomised clinical trial. PLoS ONE 18(7): e0288440. DOI:10.1371/journal.pone.0288440

[28] Watso JC, Robinson AT, Singar SAB et al. (2024). Advanced cardiovascular physiology in an individual with type 1 diabetes after10-year ketogenic diet. Am J Physiol Cell Physiol 327: C446–C461. DOI:10.1152/ajpcell.00694.2023

[29] Gardemann C, Knowles S, Marquardt T (2023). Managing type 1 diabetes mellitus with a ketogenic diet. Endocrinology, Diabetes & Metabolism, 23:008 DOI:10.1530/EDM-23-0008

[30] Koutnik AP, Klein K, Robinson AT, Watso JC. (2024). Efficacy and Safety of Long-term Ketogenic Diet Therapy in a Patient With Type 1 Diabetes, JCEM Case Reports, 2(7):luae102, DOI: 10.1210/jcemcr/luae102

[31] Tóth C, Clemens Z. (2014). Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet. Int J Case Rep Images 2014;5(10):699–703. DOI: 10.5348/ijcri-2014124-CR-10435

[32] Rydin AA, Spiegel G, Frohnert BI, et al. (2021). Medical management of children with type 1 diabetes on low-carbohydrate or ketogenic diets. Pediatric Diabetes, DOI: 10.1111/pedi.13179.

[33] Ozoran H, Matheou M, Dyson P et al. (2023). Type 1 diabetes and low-carbohydrate diets—Defining the degree of nutritional ketosis. Diabetic Medicine, 40(10);15178. DOI: 10.1111/dme.15178

[34] Korakas E, Kountouri A, Petrovski G, Lambadiari, V. (2025). Low-Carb and Ketogenic Diets in Type 1 Diabetes: Efficacy and Safety Concerns. Nutrients, 17:2001. DOI:10.3390/nu17122001

Chapter 9. Type 2 Diabetes: Remission is Real.

PART III. REFORM. FOCUS ON HUMAN BIOLOGY

Chapter 9. Type 2 Diabetes: Remission is Real.

Type 1 diabetes mellitus: Carb Control Sees Improvements in Health Biomarkers & Quality of Life.

Chapter 10. Whole of System Reform: Health Coaching Central to Reversal & Remission of Metabolic & Mental Illness.

RETURN TO CONTENTS PAGE.

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